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HomeMy WebLinkAbout0178 CASTLEWOOD CIRCLE - Health 178-CASTLEWOOD CIR.,.HYANNIS' A=272-Q35 o m I� r TOWN OF BARNS ABLE LOCATION s'�LE. ' SEWAGE # VILLAGE f/ ASSESSOR'S MAP & LOT 2 72_ 63T INSTALLER'S NAME&PHONE NO. 4e ? ?S^ 27 SEPTIC TANK CAPACITY LEACHING FACILITY: (type)aE-— C. (size)1L d2,s'-e2 NO. OF BEDROOMS'% / BUILDER OR OWNER PERMTTDATE: "re—/3 �. COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If.any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � . ' - I � i ' ' r 7� �� ._ �, N � II .� , � :�.. � ��� e' � - �-_ -*: s;. No. ? g Fee $5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: y Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Appliration for ;Digpoga[ *paem Congtruction Permit Application for a Permit to Construct( )Repair(xx)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 17 8 Castlewood C i r, Owner's Name,Address and Tel.No. 5 0 8—7 9 2—7 2 7 0 Assessor'sMap/Parcel Hyannis, MA Robert Deblinger 46 Plainfield Ave `Z7Z- 0357 Shrewsbury,MA 01545 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service PO Box 1089 , Centerville,.MA Type of Building: Dwelling No.of Bedrooms 2/3 Lot Size sq. ft. Garbage Grinder(no) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil gravel Nature of Repairs or Alterations(Answer when applicable) Title 5 LE ach i ng consisting of D-box and two 500-gallon precast leach chambers . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is oard of ealth. Signed b Date Application Approved by _ Date r-' 8_9 Application Disapproved for the following reasons Permit No. Date Issued �-�/3 x. .«••:.:.vw-.•+r...."r.-..� Fr'... _ .. �-�. a. », :r'r _ ...e.--- -.ram,.- ,—.,-,Y..� `�y Fee $5 0.0 0 No. / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,MASSACHUSETTS -Application Jor Migonl *p.5tem Construction Permit Application for a Permit to Construct( )Repair kx)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 178 Castlewood Cir, ner's Name,Address and Tel.No. 5 0 8—7 9 2—7 2 7 0 Assessor'sMap/Parcel Hyannis, MA` Robert Deblinger 46 Plainfield Ave -07 Z - 03 S Shrewsbury,MA 01545 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service PO 'Box 1089, Centerville,MA Type of Building: Dwelling No.of Bedrooms 2/3 of S*2 _ sq.ft. Garbage Grinder(no) Other Type of Building �No� of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ' gallons per day'i Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil gravel Nature,of Repairs or Alterations(Answer when applicable) Title 5 LEaching consisting of ;D-box and two 500-gallon precast leach chambers. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system F� in accordance with the provisions of'Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by hi oard o ealth. Signed i l Date Application Approved by Date 3^/ 00, Application Disapprovedpfor the following reasons / Permit No. _ Date Issued THE,,COMMONW_E•ALTH OF MASSACHUSETTS /tom r _µ �,..,,.,,..._....,� . , Deblinger BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired (xx)Upgraded Abandoned( )by at 178 Castlewood Cir, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. qg 7 dated Installer W E Robinsons Septic Sry Designer The issuance of this permit shall not be construed as a guarantee that the systeNw' unction as designed. Date ,�"— q . L Inspector 1 Q Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Deblinger Mwi5po5al *pgtem Con.5truction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 178 Castlewood Cir Hyannis MA Installer W E Robinson Septic Sry and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. i Provided: Construction must be completed within three years of the date of this liermit. f Date: r/ Approved by , — r NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR.A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) Z © 3 I, _William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated 13-�1 , concerning the property located at 178 Castlewood Circle, Hyannis, meets all of the following criteria- * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: / A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) `r B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: DATE ,<—/ 3 " LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 ' (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). �: r �� `" . � � y � � �. w � � , , - � ` € . - ;� � . f TOWN OF BARNS ABLE t�-e SEWAGE# LOCATION .� ? , d• ASSESSOR'S MAP &LOT G? 4 vjLLAGE INSTALLER'S NAME&PHONE N0. SEPTIC,-TANK CAPACITY LEAC16G:FACILITY: (type) 7 NO.OF:-BEDROOMS - BUILDFR.QR OWNER T . �--� COMPLIANCE DATE: PERMTTDATE: Separation.Distance Between the: Feet usted Groundwater Table and Bottom of Leaching Facility Maximum Add Facility (If any wells exist Feet private Water Supply Well and Leaching on site or within 200 feet of leaching any Wetlands exist Feet Edge of Wetland and Leaching Facility wittvn 300 feet of leaching facility) Furnished by a - �, TOWN OF BARNSTABLE ,r��'�3 LOCATION 7d 'L4/ �,w Gill SEWAGE # '= VILLAGE ASSESSORS MAP & LOT INSTALLER'S NAME Cz PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY DQIJ LEACHING FACILITY:(type) �� (si) y 'NO. OF-BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ...R t DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: L7 VARIANCE GRANTED: •Yes No Z_� .:. ' , . `. O t V K ASSESSORS MAP NO: PARCEL NO.: - 3zs No... o �C,�^. � f�. FFE, THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Q.W. '1.....................oF..8SLmsUL.......................................................... ApplirFatiun for Di-qVuuFal 10orkfi Tonfitrurtiura ramit Application is hereby made for a Permit to Construct ( ) or Repair (4) an Individual Sewage Disposal System at: ...01i6�,. {�.r+��3------------------ -------------------------------------------------------------------------------- Lo ation-Ad ress or t N .............................................. .l. .o.... h��aa�bu ,r ,..�n a ,_�A.o��saS. f Owner , Addr ss --_.... -•----••..------••--•......--•-•-•-•--••......._ V. you...................... Installer Addt "` U Type of Building Size of............................Sq. feet Dwelling—No. of Bedrooms.....................3------------------Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity.._____.._..gallons Length................ Width................ Diameter................. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................. •-•••••••---------•-••-....------------------ Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---_------_-_-____------ t=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•----------------------------------------------------•-•-------------------------------•--..........---•-•---••-•-•------..............--••••--....-- 4 0 Description of Soil........................................................................................................................................................................ U ---••-••-----------•----•---------------•-•-------•-----•--------...-•----------•-•--•-•--•••••---••.........__.._..._......-•-••---------------•--••---••-•-••-------•-•---•..............•------•--.•. s... _ ------------------------------------------------------------------------------------------------------------------ -------------- U Nature of Repairs or Alterations—Answer when applicableZ.a.i -__�f OO.. .�_12�.�Cti�............................ --------------------------------------------------------•---------------------------•----------------------------------------------------------•-----------------------------------------------••-••---.. Agreement: The 'undersigned agrees to install. the aforedescribed Individual Sewage Disposal System in accordance with `x the rovisions of L 1111 ' .w p5 of the State Sanitary Code—The undersigned further agrees not to place the system in A operation until a Certificate of Compliance has been issued Zbjthn..board of health. SignedT.. D w Date Application Approved By.................... Date Application Disapproved for the following reasons-------------------------------------------------------••----•------------------.--------•-•-•-----•-----•..---•- --------------------•--.....---------•--.............-------•------------------------..........---••-----.----•-•-----•-••--------•--•----••-----•-•----•------------......----------------•------------- Date ..........................- Issued.----------•------••------••---•-•.............•------- Date No.. C�.... Fps.° a..._............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH M Dt,� ...................... 0F..1.2).br!?.S gUP Appliratiun for Dispaaal Works Tonstrnrtion - rrmit Application is hereby made for a Permit to Construct ( ) or Repair (-) ) an Individual Sewage Disposal System at: `. .. ... 1-Itar,^rlhl� Location:Address I S or Lot N l.,c p�)vrsnx, .Q>,.Ir�l,a ........ ................................ !......eta t�(trL.S a Wit-. �i�.Lst,. . /�/�l o__lsas _ ......................_.---------................. ......... .....---....._......•---._........_..- -- 1 /j n Owner y Address - .. �i )�/? r "fiAf/�A / •/Y,i�j.�.QJP.V�. GC,X'� V �r Ci�l. i ............................................................. �-` .--•--.....----•--•----............................ Installer Ad<e�s Type of Building Size Lot............................Sq. feet ' Dwelling—No. of Bedrooms....................�._____.._....._....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of. Building No. of persons............................ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures .........--•------------------•-•-•--•-•----.._........-•-•--......-•-•-•---•---••-•-•-•--•-••--••--------...-•----•-•--•--...----••••••..........---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........._.............. W .....••••................................................................................................•---------•---....----._..... ------......... 0 Description of Soil........................................................................................................................................................................ x U -••-------•--•----•--•----•------•-••-••••----------------•---------------•-••••-••-----------------------••••--•-----------------•-•••....---••---•••--•-------------•-----------------•--------------. W U Nature of Repairs or Alterations—Answer when applicable?_ta a-4 .... � Cn �'� ..T j�.:___. --------------------------------------••---•-..---•-•••-----------------•-••--••---•-•--------.....•---...-----•-••••••••••----•--------------••--•---------•------•---•••-•-•-----••••----•-•---••---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiT�_.Y. San - p :of the State Sanitary Code— The undersigned furtt er agrees not,:to place the system in operation until a Certificate of Compliance has been issued by the board of//health. Signed....= :... ................................ / Date Application Approved B -, �.. _ ;' ? ..................../ � PP PP Y '`' Date Application Disapproved for the following reasons:-----------•-------------------------------------------------•-------------------------------••--------•--•-••-- ...----•-------------------------------•-------------•--•---•------------....----------•••-••----------•--------------------------•-••••--••-•••...----------••----•--••-•------- --------------------- ten,,.. '' Date PermitNo.--- ........... Issued_...:-.................................................. Date t THE COMMONWEALTH OF MASSACHUSETTS �f'`�� BOARD OF HEALTH ....... ...........w..:!.....I........OF...... rrTL uLjIR:................................................. Trrtif iratr of TomViianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } by .. ... -------- ----------------•--------------------------------------•----•------...-----..--..-----------------------------------------..-------------- .. Installer at---------------I...7.8.........E �. — -�*rc� (:�==`-_-..... ---...---------------------------...................................................................... has been installed in accordance with the provisions of T I TILE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit ............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE..------.2...-..a sh:. --Z.................................... Inspector..... - ---••-•- r. f.`.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No... C�R FEE.... .................... Riivooa1 Works (1111nutrnrtion Virrutit Permission is hereby granted.......... .............. -•............... ---------------- -.......... ............. l Sewage to Construct ( ) or Repair Gki an Individual Disposal System &t No • Street as shown on the application for Disposal Works Construction Permit N ..�� .G� Dated...... .. —� 7 � � y.................. 1) �. Board of Health DATE........3- . ........................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS